Routine testing for hepatitis C virus (HCV) at federally qualified health centers (FQHC) can improve diagnostic rates and health outcomes while being cost-effective, according to new research published in the American Journal of Medicine.

This finding runs in contrast against the formally recommended targeted testing approach. Targeted testing was shown to have worse outcomes and a higher cost compared with routine testing, according to the study authors. There has been a surge in HCV infections due to the opioid epidemic and the United States is not expected to meet the World Health Organization’s goal of eliminating HCV by 2030, according to a press release.   

The research used simulation modeling to compare the efficacy of routine rapid testing to risk- based laboratory testing. According to the press release, data were used from 57 FGCHs to model 9 different strategies. The outcomes measured included life expectancy, quality-adjusted life years, cases identified, treated and cured, and incremental cost-effectiveness ratio.  

The study found that routine rapid testing performed by a counselor identified 68% more cases within the first month than risk-based laboratory testing. According to the press release, this resulted in a 22% reduction in liver deaths among patients with liver cirrhosis. Additionally, routine rapid-testing identified 75% of cases at FQHC, whereas risk-based testing only identified 7%.

"Routine testing at federally qualified health centers is shown to provide better health outcomes and reduced financial burden compared to targeted testing…Federally qualified health centers can serve as venues to enhance testing and treatment, reducing the impact of HCV in the country,” infectious diseases physician at Boston Medical Center and assistant professor of Medicine at Boston University School of Medicine, Sabrina Assoumou, MD, MPH, said in the press release. 

The Centers for Disease Control and the US Prevention Services Task Force updated their recommendations to include a 1-time HCV testing screening for adults 18 years of age and over. According to the press release, this provided researchers with data on cost-effectiveness. 

Reference:
Hepatitis C management at federally qualified health centers proves cost-effective (Press Release) Boston, MA, July 8, 2020, EurekAlert! Accessed July 9, 2020